Heart failure & cardiomyopathies
Viability and Outcomes With Revascularization or Medical Therapy in Ischemic Ventricular Dysfunction: A Prespecified Secondary Analysis of the REVIVED-BCIS2 Trial
Authors' conclusion
This study found that viability testing does not identify patients with ischemic cardiomyopathy who benefit from PCI. The extent of nonviable myocardium, but not the extent of viable myocardium, is associated with event-free survival and likelihood of improvement of left ventricular function.
Study context
- Population
- Patients with LVEF ≤35%, extensive CAD and viability in ≥4 dysfunctional myocardial segments, with blinded core laboratory viability characterizationof 700 randomised
- Participants
- 610 patients
- Comparison
- Percutaneous coronary intervention (PCI) vs Optimal medical therapy
- PCIn = 295
- Optimal medical therapyn = 315reference
- Primary endpoint
- All-cause death or hospitalization for HF
Methodological detailsopen-label, subgroup analysis, blinded core laboratory viability analysis, 40 UK centres
- Open-label
- Subgroup analysis
- Blinded core laboratory viability analysis
- 40 UK centres
Primary result
As reported in the abstract
All-cause death or HF hospitalization, by extent of viable and nonviable myocardium
PCI
107
events
Optimal medical therapy
114
events
Hazard ratio (95% CI)
Viable myocardium (per 10% increase)
0.98(0.93–1.04)
Nonviable myocardium vs Optimal medical therapy
1.07(1.00–1.15)
Secondary outcomes
All-cause death, CV death, HF hospitalization, improved LV function at 6 months
- Extent of viable myocardium not associated with any secondary outcome
- Extent of nonviable myocardium associated with all-cause death, CV death and improvement in LV function
Original publication
Viability and Outcomes With Revascularization or Medical Therapy in Ischemic Ventricular Dysfunction: A Prespecified Secondary Analysis of the REVIVED-BCIS2 Trial. JAMA Cardiol. Published 1 December 2023. doi:10.
Summarised from the published abstract; every number is checked against it